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Background： Thin endometrium is associated with poor reproductive outcomes; estrogen treatment can increase endomctrial thickness （EMT）. The aim of this retrospective cohort study was to investigate the factors influencing the effectiveness of estrogen treatment and reproductive outcomes after the treatment in patients with thin endometrium. Methods： Relevant clinical data of 101 patients with thin endometrium who had undergone estrogen treatment were collected. Possible factors influencing the effectiveness of treatment were analyzed retrospectively by logistic regression analysis. Eighty-seven infertile women without thin endometrium who had undergone assisted reproduction served as controls. The cases and controls were matched for age, assisted reproduction method, and number of embryos transferred. Reproductive outcomes of study and control groups were compared using Student＇s t-test and the Chi-square test. Results： At the end of estrogen treatment, EMT was ≥8 mm in 93/101 patients （92.1%）. Effectiveness of treatment was significantly associated with maximal pretreatment EMT （P = 0.017） and treatment duration （P = 0.004）. The outcomes of assisted reproduction were similar in patients whose treatment was successful in increasing EMT to ≥8 mm and the control group. The rate of clinical pregnancy in patients was associated with the number of good-quality embryos transferred in both fresh （P = 0.005） and frozen-thawed （P = 0.000） embryo transfer cycles. Conclusions： Thinner EMT before estrogen treatment requires longer treatment duration and predicts poorer treatment outcomes. The effectiveness of treatment depends on the duration of estrogen administration. Assisted reproductive outcomes of patients whose treatment is successful （i.e., achieves an EMT ≥8 mm） are similar to those of controls. The quality of embryos transferred is an important predictor of assisted reproductive outcomes in patients treated successfully with exogenous estrogen.

Objective Patients undergoing surgery for endometrial intraepithelial neoplasia (EIN) have a high likelihood of concurrent endometrial cancer (EC). Lymph node dissection (LND) may be required during the operation. Our aim was to predict the presence of cancer and identify which patients might require lymph node dissection preoperatively. Materials and methods This study included 172 patients diagnosed with EIN and operated on by gynecologic oncology surgeons between June 2020 and December 2024. Demographic data, imaging findings, examination notes, surgical details, and pathology results were recorded. Initial associations with progression to EC were analyzed using two-sample t-tests and Mann-Whitney U tests for continuous covariates, and odds ratios (OR) with 95% confidence intervals (CI) for categorical covariates. The relationships between Mayo criteria and either LND or endometrial thickness(ET) were evaluated using Fisher’s exact test. All p -values were two-sided. Results A total of 172 patients were eligible for inclusion. Final pathology revealed EIN in 101 patients (58.7%) and EC in 71 patients (41.3%) after hysterectomy. The likelihood of EC increased with age (< 50 vs. ≥50 years: OR = 3.94, 95% CI: 2.00–7.79, p  < 0.001). Diabetes (OR: 2.35, 95% CI: 1.15–4.78, p  = 0.019) and hypertension (OR: 2.54, 95% CI: 1.36–4.74, p  = 0.004) were more frequently observed in patients with EC compared to those with EIN. Univariate analysis identified age ≥ 50, body mass index (BMI) ≥ 35 kg/m², postmenopausal status, diabetes, hypertension, and ET ≥ 14 mm as variables associated with occult EC. Patients with ET ≥ 14 mm had a fourfold increased likelihood of concurrent EC (aOR: 4.06, 95% CI: 1.89–8.75). Forty-four (62%) patients with endometrial cancer met the Mayo criteria, indicating a need for lymph node dissection. Conclusion Age ≥ 50, postmenopausal status, presence of diabetes and hypertension, BMI ≥ 35 kg/m², and ET ≥ 14 mm are strong predictors of concurrent endometrial cancer. These patients should be referred to gynecologic oncology, as they may require lymph node assessment, including lymphadenectomy or sentinel lymph node biopsy.

Background The decline in women's fertility becomes clinically relevant between 35–40 years old, when there is insufficient ovarian activity, and it becomes more difficult to achieve pregnancy naturally and through artificial reproductive technologies. A competent endometrium is required for establishing and maintaining a pregnancy to term, however, experts in the field underestimate the contribution of endometrial age and its impact on reproductive outcomes remains unclear. Study design A systematic search of full-text articles available in PubMed was conducted to retrieve relevant studies published until March 2023. Search terms included: endometrium, uterus, age, aging, pregnancy, and oocyte donation. Terms related to reproductive pathologies were excluded. Eligibility criteria included original, rigorous, and accessible peer-reviewed work, published in English on the effect of age on the uterus and endometrium. Results From 11,354 records identified, 142 studies were included for systematic review, and 59 were eligible for meta-analysis of endometrial thickness ( n  = 7), pregnancy rate ( n  = 22), implantation rate ( n  = 10), live birth rate ( n  = 10) and pregnancy loss rate ( n  = 11). Studies for the meta-analysis of reproductive outcomes only included transfers of embryos from ovum donation (ovum donors < 36 years old). Age shrinks the uterus; depletes endometrial blood supply through narrow uterine veins and a progressive loss of uterine spiral arteries; disrupts endometrial architecture and cellular composition; alters hormone production, shortening menstrual cycle length and impeding endometrial progression to the secretory stage; and dysregulates key endometrial functions such as adhesion, proliferation, apoptosis, and receptivity, among others. Women over 35–40 years old had significantly thinner endometrium (MD 0.52 mm). Advanced maternal age is associated with lower odds of achieving implantation (27%) and clinical pregnancy (20%), or higher odds of experiencing pregnancy loss (44%). Conclusion Due to the effect of age on endometrium reported in this review, managing patients with advanced maternal age may require considering the endometrial factor as a potential tissue to treat with anti-aging strategies. This review provides researchers and clinicians with an updated and in-depth summary of this topic, encouraging the development of new tailored anti-aging and preventive strategies for precision medicine in endometrial factor in infertility. Trial registration PROSPERO 2023 (CRD42023416947).

Aims This study aims to examine cases identified with endometrial polyp and carcinoma originating from polyps in patients presenting with gynaecological problems, and to highlight the significance of risk factors contributing to malignancy. Materials and methods The study comprised 203 patients who visited our clinic between January 2019 and 2024 with various gynaecological problems and were identified with endometrial polyps after a clinical, radiographic, and laboratory assessment. We retrospectively analysed data from 191 benign endometrial polyps and hyperplasia without atypia and 12 patients with endometrial polyps and underlying endometrial hyperplasia with atypia and/or endometrial carcinoma, diagnosed histopathologically after hysteroscopic resection, retrieved from our hospital's electronic archive system. Two hundred three participants were tested in the study, with 191 classifieds with benign tumours and 12 diagnosed with malignant tumours and atypical endometrial hyperplasia (premalignant). Cases were chosen according on consistent criteria for age, BMI, gravida, parity, abortion, educational level, smoking habits, operation history, and co-morbidities. After determining the sample size for the malignant group, patients from the control group were selected to be included in the study. Initially, patients with similar age and BMI distributions were included into the study. Next, the cases were analysed for similarities in gravida, parity, and abortion parameters, and those that matched were chosen. Following this step, the educational status was compared for resemblance, and examples with matching educational status were chosen. Consequently, the study covered a total of 34 patients, with 12 identified with malignant tumours and atypical endometrial hyperplasia (premalignant) and 22 with benign tumours. Two groups of cases were diagnosed with endometrial polyp, and risk factors that may cause the development of endometrial polyp and underlying carcinoma: age, gravida, parity, abortion, education level, smoking, previous operation history, comorbidity, gynaecological complaints, fasting blood sugar, CRP values, haemoglobin, and haematocrit were evaluated in terms of endometrial polyp sizes, endometrial thickness level, and endometrial polyp localization. By examining the pathological risk factors of these cases, particularly during the premenopausal period, the goal is to predict endometrial cancer, the most prevalent gynaecological cancer in women, along with its antecedents, and implement preventive measures proactively. Results Age, BMI, gravida, parity, number of abortions, educational status, smoking status, operation history, co-morbidity, and complaint variables did not exhibit a statistically significant difference between the groups ( p  > 0.05). It was revealed that the FBG level, CRP level, Polyp length and Endometrial thickness level of the malignant group were statistically significantly higher than the benign group ( p  < 0.01) ( p  < 0.05). Upon analysing the FBG distribution among groups, it is noted that the ODDS ratio is 10.20 for FBG values of 122.5 and above (95% CI: 1.97 – 52.78). Upon analysing the CRP distribution by groups, it is noted that the ODDS ratio is 231 for CRP values of 9.7 and above (95% CI: 13.15 – 4058.67). Upon analysing the distribution of Polyp length based on groups, it was determined that the ODDS ratio is 13.5 for Polyp lengths of 2.25 and above (95% CI: 2.47 – 73.71). Upon analysing the distribution of EM thickness based on groups, it is shown that the ODDS ratio is 5.25 for EM thicknesses of 11 and above (95% CI: 1.09 – 25.21). Conclusion Endometrial polyps are common benign growths that are typically not seen as cancer precursors but may be linked to cancer in people with advanced age. It is vital to remember that in cases of endometrial polyps, variables such as increasing polyp length, endometrial thickness, fasting glucose level, and elevated CRP levels are significant risk factors for the development of cancer associated with polyps.

PurposeSome proliferative and neoplastic changes can be seen in the endometrium of breast cancers using tamoxifen adjuvant therapy (TMX-BC). Identifying risk groups is crucial, but methods and frequency of endometrial follow-up are still controversial. This study aimed to investigate the clinical, ultrasonographic, and inflammatory factors to differentiate pathological endometrium in TMX-BC.MethodsThis study retrospectively analyzed endometrial biopsy results of TMX-BC (n 361). Normal endometrium (Group I, n 237) and pathological endometrium (Group II, n 124) were compared for clinical, ultrasonographic, and inflammatory features. Neutrophil and platelet to lymphocyte ratio (NLR; PLR), mean platelet volume (MPV), platelet distribution width (PDW), red blood cell distribution width (RDW), and lymphocyte–monocyte ratio (LMR) were the inflammatory markers.ResultsThe majority of TMX-BC with endometrial biopsy were asymptomatic (72.6%) and had normal endometrium (65.7%). Pathologic endometrium included endometrial polyp (31.9%), endometrial hyperplasia (1.7%), and endometrial cancer (0.8%). The duration of tamoxifen, cancer stage, vaginal bleeding, and menopause was similar in Group I and Group II (p > 0.05). Group II had increased endometrial thickness (11.22 ± 5.44 mm) compared to Group I (8.51 ± 3.43 mm). Group II had higher RDW and PDW than Group I (p < 0.05). Endometrial thickness ≥ 10 mm had significant diagnostic potential in postmenopausal women (AUC 0.676, p 0.000, CI 0.5–0.7), but not in premenopause.ConclusionPDW and RDW may be promising markers for pathological endometrium differentiation, but these preliminary findings should be validated by clinical studies. Measurement of endometrial thickness in asymptomatic patients may predict high-risk women with pathological endometrium in postmenopausal women. Further studies are needed in premenopausal women and those using tamoxifen for more than 5 years.

Background Abnormal uterine bleeding (AUB) is a prevalent clinical concern, particularly in women approaching or beyond menopause. With a myriad of possible etiologies ranging from benign hyperplasia to malignant transformations, accurate diagnosis becomes crucial. This study aims to examine the histopathological patterns of the endometrium in peri- and postmenopausal women presenting with abnormal uterine bleeding and correlate these findings with endometrial thickness (ET) measured by transvaginal sonography (TVS). Methods A retrospective cohort of 307 women aged 40 and above presenting with abnormal uterine bleeding was evaluated over a year period. Clinical history and transvaginal sonography findings were meticulously recorded. Endometrial samples obtained through biopsy or curettage were studied. The correlation between endometrial thickness and histological diagnosis was statistically analyzed using Mann-Whitney U Test and Chi square test, with a focus on distinguishing functional, benign, pre-malignant, and malignant endometrial pathologies. Results Endometrial polyp is the most frequent pattern in both perimenopausal and postmenopausal women. An ET > 11 mm in peri menopausal and postmenopausal women showed a strong association with hyperplasia and malignancy. This suggests that transvaginal sonography, as a non-invasive tool, can significantly guide diagnostic and management strategies when interpreted alongside clinical and histopathological parameters. Conclusion Endometrial thickness serves as a valuable adjunct in the evaluation of abnormal uterine bleeding. However, the gold standard for a conclusive diagnosis is endometrial tissue biopsy. Integrating histopathology with imaging findings enhances diagnostic precision, allowing early identification of precancerous and cancerous lesions, especially in the postmenopausal cohort. Our study concludes that endometrial sample is recommended when ET > 11 mm in perimenopausal and ET > 5 mm in postmenopausal women, particularly when bleeding is persistent.

Aims: The trend toward minimally invasive methods over basic classical techniques in surgical procedures is rapidly increasing. This study aimed to evaluate the sensitivity of blind biopsy (BB) vs. hysteroscopy-guided biopsy (HGB) for diagnosing malignancy in patients with endometrial pathology. Methods: This retrospective study included patients who underwent a BB (Group BB) and HGB (Group HGB) because of persistent uterine bleeding or unaltered ultrasonography findings after the initial biopsy at a tertiary facility from October 2022 through July 2023. Patients with a known history of malignancy were excluded. The primary objectives were to compare the performance of the two procedures and calculate a cut-off of endometrial thickness (ET) for a malignancy diagnosis. Results: The study included 150 patients (mean age: 46.20 [+ or -] 11.26 years in Group BB and 46.98 [+ or -] 9.77 years in Group HGB, p=0.520). The frequency of endometrial polyps was higher in group BB (61.3% vs. 35.3%, p<0.001), whereas functional endometrium was more frequent in group HGB (41.2% vs. 22%, p<0.001). Mean ET was similar in the two groups (Group BB vs. Group HGB: 11.21 [+ or -] 4.96 mm vs. 10.31 [+ or -] 5.63 mm, p=0.150). The cut-off of ET in predicting endometrial malignancy was 12.5 mm with a sensitivity of 75% and specificity of 74.6% [area under the curve: 0.775, 95% confidence interval: 0.6150.935; p=0.009]. Conclusions: The presented study showed no difference between HGB and BB in identifying benign endometrial pathologies. A cut-off of 12.5 mm ET was determined to predict malignancies, though the event rate was low to perform robust calculations. Keywords: Hysteroscopy guided biopsy, blind biopsy, abnormal uterine bleeding, endometrial thickness, endometrial pathologies

IntroductionThe relationships between the outcome of frozen-thaw embryo transfer (FET) cycle and endometrial compaction were not quite consistent.ObjectiveTo analyze the relationship between the outcome of FET cycle and endometrial compaction.Materials and methodsA total of 1420 women using FET were researched. The change in endometrial thickness on ET day and those on the day of progesterone (P) administration start is the basis for grouping. Group 1 was endometrial compaction group, and group 2 was the endometrial non-compaction group. Outcome measure was clinical pregnancy, estradiol (E2) levels, progesterone (P) levels, endometrial morphology, and thickness in each period of FET cycle.ResultsA significantly lower clinical pregnancy rate was observed in group 2 in comparison with group 1 (43.4% vs. 55.1%, P < 0.01). In addition, P levels on the day of P administration start were lower in group 2 (0.73 ± 0.93 ng/ml vs. 0.90 ± 1.85 ng/ml, P = 0.006), while E2 levels on ET day were higher in group 2 (316.42 ± 304.95 pg/ml vs. 257.88 ± 219.15 pg/ml, P = 0.001) than in group 1. The binary logistic regression analysis showed a lower rate of clinical pregnancy in group 2 (aOR = 0.617, 95% CI 0.488-0.779, P = 0.001).ConclusionsClinical pregnancy rates were significantly higher in women with endometrial compaction on ET day compared to women with no changes or thickening. Therefore, we recommend paying closer attention to endometrial compaction in women undergoing FET as a method to estimate endometrial receptivity.

The present study was conducted to analyze uterine measurements and endometrial thickness throughout the menstrual cycle in Saudi healthy females of reproductive age. This cohort study was conducted at Princess Nourah bint Abdulrahman University, Saudi Arabia, among thirty-three females of reproductive age who underwent trans-abdominal pelvic ultrasound scans across four menstrual cycle phases. Data analysis was conducted using SPSS version 26, utilizing descriptive statistics, one-way ANOVA, correlation, and regression analysis. Endometrial thickness and layers showed significant variations (p<0.001) across menstrual phases (early proliferative: 0.59 ± 0.21 cm, late proliferative: 0.77 ± 0.24 cm, secretory: 1.09 ± 0.40 cm, menstrual: 0.52 ± 0.35 cm). Endometrial thickness was positively correlated with number of layers (r=0.576, p<0.05). The study showed that the average uterine length, width, and thickness were 7.33 ± 0.76 cm, 3.93 ± 1.00 cm and 3.44 ± 0.55 cm, which showed stability across menstrual phases, except for width showing slight variations. Endometrial thickness was positively correlated with uterine thickness (r=0.358, p<0.05). The study results emphasize the significance of using region-specific reference values in clinical practice. This approach would enable precise evaluation and treatment of gynecological problems. It is encouraged to do future study with larger populations in order to validate these results and improve the therapeutic applicability.

PurposeTo evaluate whether endometrial compaction using sequential transvaginal ultrasound is associated with improved live birth rates in medicated single euploid frozen embryo transfer (FET) cycles.MethodsProspective observational cohort study at a private fertility clinic. Patients who underwent FETs between January and December 2018 were assessed for inclusion. The change in endometrial thickness between the end of the estrogen phase and the day before embryo transfer, measured by sequential transvaginal ultrasound, was used to categorize cycles with compaction (≥ 5%), no change, or expansion (≥ 5%). FET cycle outcomes were then compared between groups. The primary outcome was live birth. Secondary outcomes include clinical pregnancy rate and rate of spontaneous abortion.ResultsOf the 259 single euploid medicated FETs performed during the study period, only 43/259 (16.6%) of the cycles demonstrated ≥ 5% compaction, whereas 152/259 (58.7%) expanded and 64/259 (24.7%) were unchanged. Live birth rates did not differ between cycles with compaction (58.1%), no change (54.7%), or expansion (58.6%), p = 0.96. Clinical pregnancy and spontaneous abortion rates were also similar between groups.ConclusionThe vast majority of cycles did not demonstrate endometrial compaction. Endometrial compaction is not associated with live birth rate or spontaneous abortion rate in medicated single euploid FETs in this cohort.